Page 201 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

180 PART III Therapeutic Modalities for the Cancer Patient

adenocarcinoma was achieved in one dog, and a combination of 2. Blackburn AL, Berent AC, Weisse CW, et al.: Evaluation of outcome
58
transarterial embolization, systemic chemotherapy, and cryoabla- following urethral stent placement for the treatment of obstructive
carcinoma of the urethra in dogs: 42 cases (2004–2008), J Am Vet
tion resulted in partial tumor remission in a dog with a maxillary
VetBooks.ir fibrosarcoma. 59 3. McMillan SK, Knapp DW, Ramos-Vara JA, et al.: Outcome of ure-
Med Assoc 242:59–68, 2013.
Other thermal ablation techniques demonstrating promise and
being used more regularly in human patients include HIFU and thral stent placement for management of urethral obstruction sec-
ondary to transitional cell carcinoma in dogs: 19 cases (2007–2010),
60
laser ablation. The use of HIFU for the treatment of a hepatocel- J Am Vet Med Assoc 241:1627–1632, 2012.
lular adenoma has been reported in one dog, and investigation 4. Weisse C, Berent A, Todd K, et al.: Evaluation of palliative stenting
61
into other options is currently ongoing. Laser ablation performed for management of malignant urethral obstructions in dogs, J Am
with ultrasound guidance has been described for the palliative Vet Med Assoc 229:226–234, 2006.
treatment of lower urinary tract transitional cell carcinoma in 5. Berent AC, Weisse C, Beal MW, et al.: Use of indwelling, double-
dogs. In a series of dogs undergoing this procedure, the median pigtail stents for treatment of malignant ureteral obstruction in dogs:
62
survival time was 380 days. 62 12 cases (2006–2009), J Am Vet Med Assoc 238:1017–1025, 2011.
Irreversible electroporation (IRE) is another promising abla- 6. Schlicksup MD, Weisse CW, Berent AC, et al.: Use of endovascular
tion technique. For this technique, high-frequency electrical stents in three dogs with Budd-Chiari syndrome, J Am Vet Med Assoc
235:544–550, 2009.
energy is applied to tumor tissue and causes electroporation with 7. Culp WT, Macphail CM, Perry JA, et al.: Use of a nitinol stent to
63
increased permeability of cell membranes. The damage results palliate a colorectal neoplastic obstruction in a dog, J Am Vet Med
in cellular apoptosis. Although this technique has not been used Assoc 239:222–227, 2011.
in companion animals with spontaneous tumors, the potential 8. Culp WT, Weisse C, Cole SG, et al.: Intraluminal tracheal stenting
is tremendous, as the nonthermal electrical characteristic of IRE for treatment of tracheal narrowing in three cats, Vet Surg 36:107–
prevents damage to adjacent structures, such as vessels and nerves, 113, 2007.
63
and a higher specificity in tumor targeting. 9. Hansen KS, Weisse C, Berent AC, et al.: Use of a self-expanding
metallic stent to palliate esophageal neoplastic obstruction in a dog,
J Am Vet Med Assoc 240:1202–1207, 2012.
Drainage 10. Hume DZ, Solomon JA, Weisse CW: Palliative use of a stent for
colonic obstruction caused by adenocarcinoma in two cats, J Am Vet
IO techniques provide minimally invasive options for establishing Med Assoc 228:392–396, 2006.
drainage secondary to malignant obstructive disease. The drainage 11. Radhakrishnan A: Urethral stenting for obstructive uropathy utiliz-
can occur from organs that should normally be able to drain inde- ing digital radiography for guidance: feasibility and clinical outcome
pendently (e.g., gallbladder, renal pelvis, and bladder) and body in 26 dogs, J Vet Intern Med 31:427–433, 2017.
cavities containing malignant effusions. Access to these organs is 12. Christensen NI, Culvenor J, Langova V: Fluoroscopic stent place-
often possible with ultrasound guidance. ment for the relief of malignant urethral obstruction in a cat, Aust
Drainage catheters are generally designed with several fea- Vet J 88:478–482, 2010.
tures that assist in catheter placement and enhance mainte- 13. Brace MA, Weisse C, Berent A: Preliminary experience with stenting
nance of the catheter when in position, including a stiffening for management of non-urolith urethral obstruction in eight cats,
cannula, insertion needle, and pigtail (often with a lock). A Vet Surg 43:199–208, 2014.
modified Seldinger technique can often be used for placement 14. Eckman WW, Patlak CS, Fenstermacher JD: A critical evaluation
of the principles governing the advantages of intra-arterial infusions,
of a drainage catheter. Using ultrasound guidance, an over-the- J Pharmacokinet Biopharm 2:257–285, 1974.
needle catheter is introduced into the organ or cavity in which 15. Aigner KR: Intra-arterial infusion: overview and novel approaches,
the drainage catheter will be placed; alternatively, the inser- Semin Surg Oncol 14:248–253, 1998.
tion needle within the drainage catheter can just be directly 16. Chen HS, Gross JF: Intra-arterial infusion of anticancer drugs: theo-
inserted. If an over-the-needle catheter is used, a guide wire retic aspects of drug delivery and review of responses, Cancer Treat
can be inserted through the catheter into the organ or cavity. Rep 64:31–40, 1980.
The over-the-needle catheter is then removed, and the drain- 17. Bertino JR, Boston B, Capizzi RL: The role of chemotherapy in
age catheter (with stiffening cannula) is passed over the guide the management of cancer of the head and neck: a review, Cancer
wire into the drainage site. Once appropriately positioned, the 36:752–758, 1975.
stiffening cannula can be removed and the drainage catheter 18. von Scheel J, Golde G: Pharmacokinetics of intra-arterial tumour ther-
apy. An experimental study, Arch Otorhinolaryngol 239:153–161, 1984.
advanced over the guide wire, if required. Once the drainage 19. Stephens FO: Clinical experience in the use of intra-arterial infusion
catheter is properly positioned, the guide wire can be removed, chemotherapy in the treatment of cancers in the head and neck, the
and the pigtail loop can be locked. extremities, the breast and the stomach, Recent Results Cancer Res
Veterinary IO has a promising future. Currently, IO tech- 86:122–127, 1983.
niques are offered in many specialty practices. As knowledge of 20. Sakata K, Aoki Y, Karasawa K, et al.: Analysis of the results of com-
the options and exposure to the instrumentation increases, so will bined therapy for maxillary carcinoma, Cancer 71:2715–2722, 1993.
the experience with these cases and critical evaluation in the vet- 21. Robbins KT, Kumar P, Regine WF, et al.: Efficacy of targeted supra-
erinary literature. It is likely that advances in IO diagnostics and dose cisplatin and concomitant radiation therapy for advanced head
treatments will mirror what is seen in human medicine and the and neck cancer: the Memphis experience, Int J Radiat Oncol Biol
translational potential is outstanding. Phys 38:263–271, 1997.
22. Boeckman HJ, Trego KS, Turchi JJ: Cisplatin sensitizes cancer cells
to ionizing radiation via inhibition of nonhomologous end joining,
References Mol Cancer Res 3:277–285, 2005.
23. Rabbani A, Hinerman RW, Schmalfuss IM, et al.: Radiotherapy
1. Culp WT, Mayhew PD, Pascoe PJ, et al.: Angiographic anatomy and concomitant intraarterial cisplatin (RADPLAT) for advanced
of the major abdominal arterial blood supply in the dog, Vet Radiol squamous cell carcinomas of the head and neck, Am J Clin Oncol
Ultrasound 56:474–485, 2015. 30:283–286, 2007.